Low back pain has low back pain can not be straight, low back pain can not stoop, low back pain but not up, low back pain with headache, low back pain foot straight pain, back bone pain (lumbar disc protrusion), low back and leg pain, low back and leg tendon pain, liver and kidney deficiency is also low back pain chest tightness (hepatitis), confined to the lumbar pain is mostly related to lumbar spine joint disorder, muscle inflammation, fracture, tuberculosis and tumor. This category of patients have lumbar sprain or sudden lumbar pain, there is obvious localized pressure pain in the lumbar spine during the examination, which is basically consistent with the site of the patient’s self-perception, and the patient has limited lumbar activities.
1.Lumbar fibrous tissue inflammation: lumbar pain is aggravated when lying in bed, but reduced after getting up. When the temperature is colder, the humidity increases, or when it is rainy and cloudy during the “yellow plum” season, the lumbar pain is triggered to increase.
2.Supraspinous ligament or interspinous ligament lesion: the lumbago is in the superficial part of the spinous process, with sharp stabbing pain or cutting-like pain.
3.Lumbar muscle strain, mostly manifested as chronic dull pain
①Soreness or swelling pain in the lumbar region, partly stabbing pain or burning pain.
It is aggravated by exertion, reduced by rest, reduced by proper activity and frequent change of position, and aggravated by excessive activity.
(3) Inability to work with bending. Often forced to stretch the waist or hit the waist with the fist to relieve the pain.
④There are pressure points in the lumbar region, mostly at the sacrospinous muscle, the posterior part of the iliac spine, the stopping point of the sacrospinous muscle behind the sacrum or the transverse process of the lumbar vertebrae.
⑤ The shape and activities of the lumbar region are mostly abnormal, and there is no obvious lumbar muscle spasm, and the lumbar activities are slightly restricted in a few patients.
4.Lumbar degenerative lesions: the time of day when the lumbar pain is aggravated: early in the morning when you wake up, that is, the lumbar pain, when a little lumbar activity can be significantly relieved again.
5, AS patients show morning stiffness, slightly relieved after activity, ankle pain and other characteristics. The sacroiliac joint torsion test is positive, and there is rarely obvious radicular radiating pain, which cannot be completely relieved by rest; the blood sedimentation is fast, and the histocompatibility antigen B27 (HLA-B27) is positive. x-ray shows that the sacroiliac joint widens, the edge is serrated, there is sclerosis of the subchondral bone, the joint surface is blurred in the later stage, and the joint space is narrowed or even completely fused.
AS New York criteria.
(1) The lumbar spine is restricted in all 3 directions: anterior flexion, lateral bending and retroversion.
(2) History of pain in the lumbar spine or at the dorsolumbar junction lasting for more than 3 months.
(3) Restricted thoracic expansion, measured at the 4th intercostal space, with thoracic expansion ≤ 2.5 cm.
6, chronic myofascial lumbago: chronic lumbar occult pain, distension, soreness, and fixed location of lumbar pain; skin at the site of the lumbar dorsal sclerosis often has sensory impairment and no sweating; forward bending is limited, no other impairment; its pressure point is at the tip of the transverse process of the third lumbar vertebra, often with inductive pain, and the lumbosacral region is easy to touch the sclerosis. Sacrospinous muscle or lumbar dorsal fascia lesion: lumbar pain is limited to soft tissues on both sides.
7, lumbar spine slippage: mostly seen in adults, lumbar spine slippage refers to a disorder in which the lumbar vertebrae are partially or completely misaligned, which is generally called slipped vertebrae clinically, and generally the superior vertebrae are slipped forward. Lumbar pain in the lumbosacral region and buttocks and radiating numbness and pain in one or both lower limbs. The pain is aggravated by exercise and weight-bearing and alleviated by bed rest; the lumbar forward flexion is restricted significantly, and the back flexion is rarely restricted; the trunk becomes shorter when the slippage is obvious, and the umbilicus is near the pubic bone, and there is a circular deep groove on the iliac wing of the posterior lumbar region. x-ray oblique position is like a circle on the neck of a hound dog.
8, lumbar rheumatoid: chronic disease capacity, mobility; low back pain and weather-related, long duration of the disease, the pain disappears after tonicity, more than no neurological symptoms, activity is limited, tonicity after the lumbar arch backbend; blood sedimentation, anti-“O” accelerated, rheumatoid factor is mostly positive. x-ray visible sacroiliac joint blurred, iliac joint surface near sclerosis and laxity alternately, calcification of the ligaments around the spine in the form of bamboo-like changes.
9, posterior lumbar joint synovial impingement: the attack has more lumbar forward flexion plus rotation, pain is intense, mainly in the lumbar region, pressure pain site is mostly in the small joints, radiation is not obvious.
10, chronic osteo-fascial interval syndrome: aggravated after activity, prolonged sitting and standing, prolonged walking, bed rest in fixed position and prolonged bending.
11, lumbar spine tuberculosis: early only lumbar pain, easily confused with strain, pediatric and youth, mostly without neurological symptoms, may have angular posterior convexity deformity, activity restriction; fast blood sedimentation, chronic disease capacity, cold abscess, positive pick-up test. x-ray can be seen narrowing of the vertebral space, destruction of the vertebral body, abscess shadow of the psoas major muscle.
12, spinal tumor or intra-vertebral canal occupying lesion: no obvious major pain in the back during the day, after the night, the back pain increases, intense burning pain and nocturnal pain, unstable gait or hobbling. Where the patient’s legs or feet in a short period of time appear muscle strength loss to highly suspect intravertebral canal occupations, remember!!!!
13.Sacroiliac joint subluxation is triggered by the traction of ligaments and mild displacement of the joint due to twisting of the body. It is mostly seen in athletes and menstruating mothers, and is also one of the causes of low back pain, which can easily lead to underdiagnosis and misdiagnosis.
14.Patients with sacroiliac joint lesions sometimes also have the realization of low back pain, but their pain is focused on the sacroiliac joint site, often with obvious history of trauma and strain, pain in the lumbosacral and lateral hip, pain is aggravated when standing on one foot on the affected side, pain cannot be bent when the lumbar region is overextended or rapidly rotated, weight-bearing on the healthy side of the hip when sitting, heavy people cannot turn over in bed, pain can be radiated to the lower limbs, there is pain when pressing the sacroiliac joint. The pain can be radiated to the lower extremities, and there is pain when pressing the sacroiliac joint, and the pain is aggravated by percussion, the lumbar muscle is tense, the “4” test of the lower extremities is positive, the straight leg raising test can be false positive, the pain is mainly in the sacroiliac joint, there is no obvious radiating pain in the lower extremities, the pelvic separation test and pelvic compression test are positive, and the X-ray film shows unequal width of the sacroiliac joint gap on both sides. The lumbar pain is concentrated in the lumbosacral joint or near the sacroiliac joint: suspicious lumbosacral joint strain or sacroiliac arthritis.
Pain limited to the lumbar region with no restriction of lumbar movement
Patients feel conscious lumbar pain, lumbar activities are not restricted, and there is no specific pressure pain site in the lumbar region on physical examination. This condition usually belongs to the reflection of having internal diseases in the local area, such as kidney deficiency, female pelvic inflammatory disease, adnexitis, kidney stones, pyelonephritis, etc.
1.Urological stones: It is a sudden “knife-cutting”-like cramping pain in one side of the lumbar abdomen, radiating to the lower abdomen, perineum and inner thigh in the direction of ureteral travel, which can last for several minutes to several hours. During the attack of low back pain, the patient is bent over and arching his back, sitting and lying down, pale and sweating profusely. The pain is often followed by varying degrees of hematuria.
2.Urinary tract infection: low back pain with frequent urination, urgent urination and painful urination suggests possible pyelonephritis.
3.Kidney disease: low back pain with percussion pain in the kidney area should be considered pyelonephritis, renal tuberculosis, perinephric abscess, etc.
4.Lumbago with increased leucorrhea is mostly caused by inflammation of the reproductive system. Such as cervicitis, pelvic inflammatory disease, adnexitis, etc.
5.Pelvic varicose veins: lumbar pelvic pain, the pain site is equivalent to the level of sacro-hip region, a few in the lower half of the sacrum, often accompanied by lower abdominal pain symptoms. Ultrasound, pelvic venogram, laparoscopy.
6.Dense iliopsoas: chronic persistent lower back pain after childbirth.
7, visceral disease involved low back pain: abdominal, pelvic organs or extraperitoneal disorders can often affect the spinal nerve through the sympathetic chain or the traffic branch of the sympathetic ganglion, causing pain in the low back or legs. Such patients may have normal lumbar activities and no obvious pressure points.
8, osteoporosis: mostly seen in older women after menopause, the patient’s thoracolumbar spine is extensive osteoporosis, bone trabeculae become thin, less, the vertebral body is concave-shaped changes, taking estrogen or calcium and other drugs can make the pain relief.